Evaluation of sensitivity and specificity of spatial resolution and Humphrey automated perimetry in pseudotumor cerebri patients and normal subjects.

To determine the sensitivity and specificity of high-pass resolution perimetry ("ring test"), 18 patients with pseudotumor cerebri (PTC) and 18 age-matched controls were examined with the Humphrey program 24-2 and the ring test. Goldmann perimetry also was done to determine if defects found with the ring test were present with another method. Testing with Humphrey perimetry revealed defects in 15 PTC patients and four control subjects; with the ring test, 13 PTC patients and two control subjects had abnormalities. The disturbed areas in the control subjects with both automated tests were not reproducible. Humphrey perimetry had a sensitivity of 83% and the ring test, 72%. The specificities were Humphrey perimetry, 78% and the ring test, 89%. These differences were not statistically significant. Qualitative assessment of the presence and extent of damage using the pointwise probability plots and graphically displayed raw data showed good correlation of the tests in 11 of the 18 patients. The lack of correlation in four of the patients was caused by the presence of a generalized depression or a peripheral contraction on the Humphrey test; this defect, not present on retesting, may have been related to fatigue or poor motivation. The ring test is a sensitive and specific perimetric technique in patients with PTC.

Effects of scleral reinforcement on the elongation of growing cat eyes.

OBJECTIVE: We investigated the effect of scleral reinforcement on ocular elongation in the rapidly growing eyes of juvenile cats. METHODS: Bands made from donor sclera or expanded polytetrafluoroethylene were used to reinforce one eye of each animal; contralateral eyes underwent sham surgery. RESULTS: During 5 months of follow-up, normal intraocular pressures implied normal functioning of angle structures. A-scan on the central axis showed no difference in globe lengths. Direct physical measurements of the posterior aspect of the globe at enucleation revealed significant decreases in off-center lengthening where reinforcement was present compared with unreinforced areas in the same eyes and in the contralateral unbanded eyes. Venous beading in fundus photographs of three eyes suggested impairment of venous outflow. CONCLUSIONS: Scleral reinforcement appears to control expansion of the growing cat eye to a limited extent, but the effects on vision and retinal perfusion require further investigation.

Effect of a somatostatin analog (octreotide acetate) on the growth of retinal pigment epithelial cells in culture.

PURPOSE: Proliferative vitreoretinopathy is a serious complication of retinal detachment surgery in which retinal pigment epithelial cells abnormally proliferate within the vitreous cavity and under the retinal surface. Octreotide acetate, a somatostatin analog, has been shown to inhibit the cellular proliferation of a variety of cell types. The aim of this study was to investigate the effect of octreotide acetate on the growth of rabbit retinal pigment epithelial cells in culture. METHODS: Retinal pigment epithelial cells were isolated from rabbits and maintained in culture. Cells were exposed to standard media or media supplemented with octreotide acetate 10(-4) M to 10(-12) M for five days. Each concentration of octreotide acetate was tested in quadruplicate. RESULTS: Exposure of rabbit retinal pigment epithelial cells to octreotide acetate significantly inhibited proliferation with a peak effect at 10(-8) M. The effect of octreotide is biphasic with higher and lower concentrations having less effect than 10(-8) M. CONCLUSIONS: This study suggests that octreotide acetate may be useful in the treatment of proliferative vitreoretinopathy; however, the optimum therapeutic dose range for this drug may be narrow.

Ocular manifestation of simian immunodeficiency syndrome (SAIDS).

The management of opportunistic infections is a significant problem in acquired immunodeficiency syndrome (AIDS) and the development of more effective chemotherapeutic agents is needed. We present the ocular manifestations of an AIDS-like disease in rhesus monkeys experimentally infected with simian immunodeficiency virus (SIV) at the Delta Regional Primate Research Center. These findings consisted of rubeosis in the anterior segment and retinitis, optic neuritis, choroiditis and panophthalmitis in the posterior segment of the eye. Investigation of the retinas by electron microscopy revealed SIV in both eyes of one animal and a herpes virus in two animals. Serology confirmed cytomegalovirus (CMV) as the likely agent. This primate model will prove useful for both further investigations of the possible interaction between immunosuppressive lentiviruses and CMV in ocular disease and antiviral drug testing.

Retinal toxicity of intravitreous octreotide in the rabbit.

OBJECTIVE: To evaluate the ocular toxicity of intravitreous octreotide. DESIGN: New Zealand white rabbits weighing approximately 2 kg were given 5 mg (group 1, two eyes), 2 mg (group 2, four eyes), 1 mg (group 3, four eyes), 0.5 mg (group 4, two eyes), 0.3 mg (group 5, two eyes) or 0.1 mg (group 7, two eyes) of octreotide acetate, two doses of 0.3 mg 1 week apart (group 6, four eyes) or 0.1 mL of balanced salt solution (group 8 [control group], two eyes). OUTCOME MEASURES: Findings on clinical examination and electroretinography, performed before and 10 days after injection, and on light microscopy. RESULTS: Cataracts developed in groups 1 and 2. No clinical changes were found in groups 3 to 8. Electroretinography showed various degrees of decrease in the b-wave amplitude in groups 1 and 2; the results were normal in groups 3 to 8. Histologic examination showed macrophage and monocyte infiltration in the vitreous and retina in group 1. No histologic change was seen in the eyes in groups 2 to 8. CONCLUSIONS: Octreotide injected intravitreally is safe at dosages of 1 mg or less.

Surgical chorioretinal venous anastomosis for ischemic central retinal vein occlusion.

BACKGROUND AND PURPOSE: To report results of a pilot study to create chorioretinal venous anastomosis (CRVA) in eyes with ischemic central retinal vein occlusion (CRVO) via a pars plana approach. PATIENTS AND METHODS: Five eyes of 5 patients with ischemic CRVO underwent surgical CRVA. Following pars plana vitrectomy, the posterior hyaloid face was removed, and slit-like incisions were made with a microvitreoretinal blade adjacent to a major retinal vein in each quadrant. Small pieces of 50 Mersilene sutures (Ethicon, Somerville, NJ) were positioned over the vein and inserted into these incisions to promote vascularization. Panretinal photocoagulation was applied. RESULTS: A functional CRVA site was noted at 10 of 16 attempted sites (4 sites in 1 patient could not be evaluated because of cataract). Minor fibrous proliferation was noted at CRVA sites in all eyes. Optic atrophy developed in 3 eyes. Visual acuity improved in 3 eyes, remained unchanged in 1, and deteriorated in 1 eye after a mean follow up of 13.4 months (range 8-20 months). CONCLUSION: Surgically induced CRVA may improve the prognosis in some eyes with ischemic CRVO.

Intravitreal clindamycin and dexamethasone for toxoplasmic retinochoroiditis.

BACKGROUND AND OBJECTIVE: To present a new method for the management of toxoplasmic retinochoroiditis (TRC). METHODS: The patients were females ranging in age from 10 to 61 years (average 26.5). Four eyes of 4 patients were treated with intravitreal injections of 1.0 mg clindamycin in 0.1 mL and 1.0 mg of dexamethasone in 0.1 mL. The injections were given under general or peribulbar anesthesia. Three patients continued one systemic drug. Follow-up ranged from 11 to 26 months (mean 17.5). RESULTS: A favorable response was noted in each eye within two weeks after the intravitreal injections. All patients required 2 to 4 intravitreal injections in the affected eye for the control of TRC. Visual acuity improved in each eye. The disc and macula were preserved in all eyes. Recurrence was noted in one case, which responded to a repeated intravitreal injection of clindamycin and dexamethasone. CONCLUSIONS: Intravitreal injections of clindamycin and dexamethasone are well tolerated and may offer an additional strategy to treat TRC in patients who are unable to afford or tolerate systemic therapy, or whose disease progresses despite systemic therapy.

Intravitreal tPA and SF6 promote clearing of premacular subhyaloid hemorrhages in shaken and battered baby syndrome.

BACKGROUND AND OBJECTIVE: Child abuse is a serious problem in many cultures. The ocular signs of shaken baby include intraretinal, subretinal, and preretinal hemorrhages. The hemorrhages may be unilateral or bilateral and are seen in 50% to 80% of patients. Previous treatment was limited to observation or vitrectomy, but some observed eyes develop amblyopia, and pediatric vitrectomy has many complications. PATIENTS: We report 4 eyes in 2 children with shaken baby syndrome in whom we administered intravitreal tissue plasminogen activator (tPA) in an attempt to resolve preretinal hemorrhages earlier than observation alone without the complications of vitrectomy. The tPA dose ranged from 12.5-25 microg per injection. Eyes were injected once weekly for 3 consecutive weeks. Each time 0.25 cc of sulfur hexafluoride gas was also injected. RESULTS: Within 1 week following the last tPA administration, complete resolution of the preretinal hemorrhage was seen. There were no associated ophthalmic complications. CONCLUSION: Intravitreal tPA with an expansive gas is an alternative method to observation or vitrectomy for resolution of preretinal hemorrhages in battered babies and may allow faster resolution of hemorrhages without the complications of vitrectomy.

Closure of chronic macular holes using passive aspiration to the edges of the macular hole.

Full-thickness macular holes are characterized by central dehiscence of neurosensory tissue and a reduction in visual acuity. According to Gass (1) and then Johnson and Gass, (2) full-thickness macular holes are caused by progressive vitreous cortex condensation, resulting in tangential traction with centrifugal displacement of photoreceptor elements at the fovea.

Use of a macular buckle in the treatment of exudative age-related macular degeneration.

BACKGROUND AND OBJECTIVE: To evaluate a macular buckle for exudative choroidal neovascularization secondary to age-related macular degeneration (ARMD). PATIENTS AND METHODS: Forty-two eyes with choroidal neovascular membranes (CNVM) secondary to ARMD underwent surgical placement of a macular buckle. A Gore-Tex strip (2.0-2.5 mm wide) was button-holed through a 5 mm diameter silicone sponge (9 mm long) and placed behind the macula underneath the CNVM by the same surgeon (Dr Peyman) in all cases. Follow-up ranged from 7-76 months (mean, 20.9 months). RESULTS: Of 12 eyes with classic subfoveal CNVM: 4 (33%) gained 2 or more lines of Snellen visual acuity; 3 (25%) gained 1 line, remained the same, or lost 1 line; and 5 (42%) lost 2 or more lines (range + 6 to - 6 lines). Of 22 eyes with ill-defined subfoveal CNVM: 12 (54%) gained 1 line, remained the same, or lost 1 line; and 10 (46%) lost 2 or more lines (range + 1 to - 8 lines). Eight eyes with ill-defined juxtafoveal CNVM had the following visual acuity outcomes: 5 eyes (62%) maintained the same level of Snellen visual acuity (gained 1, 0, or lost 1 line); and 3 (38%) got worse (lost 2 or more lines of Snellen visual acuity, range + 1 to - 6 lines). Ten eyes (24%) bled subretinally during the follow-up period (average 11.5 months, range 14 days to 27 months), all outside the area of indentation of the macular buckle. CONCLUSIONS: The macular buckle treatment for exudative subretinal choroidal neovascular membranes in ARMD stabilized visual decline and displaced significant subfoveal hemorrhage.

An in vitro cataract model for practice of cataract surgery.

We have developed an in vitro cataract model using enucleated animal eyes. A cataract is produced by immersing the enucleated eyes in hypertonic sodium chloride solution for one hour and re-incubating them for another hour in normal saline solution. The model is useful for practicing various techniques of cataract extraction.

The identification and incidence of human immunodeficiency virus antibodies and hepatitis B virus antigens in corneal donors.

Forty eye banks responded to an Eye Bank Association of America (EBAA) questionnaire concerning screening patients at risk for acquired immune deficiency syndrome (AIDS) and hepatitis B. Respondents accounted for 26% (8787 of 33,500) of the total volume of eyes donated in North America in 1986. Sixty (0.68%) of 8787 donors were found to be antibody positive for human immunodeficiency virus (HIV) and 69 (1.33%) of 5187 donors were found to be positive for hepatitis B virus (HBV). The age, cause of death, and source of tissue were also studied. The finding of seropositivity for HIV in very young and elderly donors without identified risk factors underscores the need to screen all potential cornea donors for the presence of HIV antibodies. The data on HBV lend further support to the importance of such screening procedures.

Branch retinal artery occlusion (BRAO) combined with branch retinal vein occlusion (BRVO) and optic disc neovascularization associated with HIV and CMV retinitis.

Two vaso-occlusive events, branch retinal artery occlusion (BRAO) and branch retinal vein occlusion (BRVO), were observed in the retina of an HIV-infected patient with cytomegalovirus (CMV) retinitis who developed neovascularization of the disc (NVD). Although BRVO and reversible NVD have been reported in association with CMV retinitis, we have seen no reports of concomitant BRAO. CMV damages endothelial cells and causes an occlusive vasculitis. In HIV-infected individuals, damaged endothelial cells and rheologic problems result in increased blood viscosity. HIV infection has also been associated systemically with elevated levels of cytokines, including tumor necrosis factor alpha (TNF-alpha). In vitro, TNF-alpha exerts effects that decrease fibrinolytic potential; this activity in the circulation of a patient with AIDS may lead to vascular occlusive events. In the patient reported here, the retinal changes were not reversed by induction therapy with ganciclovir and the NVD did not regress.

Trauma-induced Acinetobacter lwoffi endophthalmitis with multi-organism recurrence: strategies with intravitreal treatment.

Endophthalmitis and its treatment are challenging, controversial subjects. We report here a patient whose recurrent endophthalmitis required several modes of treatment.

Antiphospholipid syndrome in a patient with sarcoidosis: a case report.

We report the case of a 72-year-old female with sarcoidosis who developed a central retinal artery occlusion in her left eye in association with persistently high titers of IgG anti-cardiolipin antibodies. Only two previous cases of antiphospholipid antibody syndrome in association with sarcoidosis have been reported. Our patient's vision stabilized on anti-coagulant therapy along with concomitant treatment of sarcoidosis-related uveitis with methotrexate.

Transpupillary CW YAG laser coagulation. A comparison with argon green and krypton red lasers.

The authors have developed a CW YAG laser for transpupillary coagulation. The effects of CW YAG coagulation on the retina, retinal vessels, and fovea were compared with those produced by the krypton red and argon green lasers. To produce threshold coagulative lesions in monkeys and rabbits, we needed five to ten times more energy with the CW YAG than with the krypton red or argon green lasers. Nerve fiber damage was observed only when coagulating retinal vessels with the argon green laser. At the parameters used, none of the lasers damaged the sensory retina of the fovea. The CW YAG may be used as a new mode of laser coagulation in the treatment of retinal diseases.

Effect of CW YAG and argon green lasers on experimentally detached retinas.

We evaluated the effects of argon-green (514.5 nm) and CW neodymium YAG (1060 nm) wavelengths on experimentally detached retinas of primates. Neither laser produced damage to the sensory retina of the fovea. The argon green wavelength, which was absorbed by haemoglobin in the vessel or by extravasated red blood cells, created vasospasm and nerve fiber layer damage. The beam of the CW YAG was not absorbed by haemoglobin; therefore, no vasospasm could be produced on experimentally detached retinas.

Long-term vitreous replacement in primates with intravitreal Vitreon or Vitreon plus silicone.

Six African green monkeys (six eyes) underwent vitrectomy and vitreous replacement with Vitreon (perfluorophenanthrene) or Vitreon plus silicone. A seventh animal served as a control. Vitreon alone and in combination remained optically clear and allowed fundus examination up to 162 days. No toxic effects to the retina were detectable. Vitreon exhibited some degree of emulsification and formed some globules at 45 days postoperatively. Interestingly, Vitreon emulsification occurred at a later time (80 days) in one of the silicone plus Vitreon eyes. The combination of silicone plus Vitreon may offer the advantage of tamponading the inferior and superior retina in phakic eyes.